Psychometric properties of the Brief Pain Inventory among patients with osteoarthritis undergoing total hip replacement surgery

<p>Abstract</p> <p>Background</p> <p>Pain is a cardinal symptom of osteoarthritis (OA) of the hip and important for deciding when to operate. This study assessed the internal consistency reliability, validity and responsiveness of the Brief Pain Inventory (BPI) among patients with OA undergoing total hip replacement (THR).</p> <p>Methods</p> <p>We prospectively included 250 of 356 patients who were accepted to the waiting list for primary THR surgery. All participants responded to the BPI, WOMAC and SF-36 at baseline and 1 year after surgery.</p> <p>Results</p> <p>Internal consistency reliability (Cronbach's α) was >0.80 for the BPI, the WOMAC and five of the eight SF-36 scales The pattern of associations of the two BPI scales with corresponding and non-corresponding scales of the WOMAC and SF-36 largely supported the construct validity of the BPI. The responsiveness indices for change from baseline to 1 year after THR ranged from 1.52 to 2.05 for the BPI scales, from 1.69 to 2.84 for the WOMAC scales, and from 0.25 (general health) to 2.77 (bodily pain) for the SF-36 scales.</p> <p>Conclusions</p> <p>The BPI showed acceptable reliability, construct validity and responsiveness in patients with OA undergoing THR. BPI is short and therefore is easy to use and score, though the instrument offers few advantages over and duplicates scales of more comprehensive instruments, such as the WOMAC and SF-36.</p

Cutpoints for mild, moderate and severe pain in patients with osteoarthritis of the hip or knee ready for joint replacement surgery

<p>Abstract</p> <p>Background</p> <p>Cutpoints (CPs) for mild, moderate and severe pain are established and used primarily in cancer pain. In this study, we wanted to determine the optimal CPs for mild, moderate, and severe pain in joint replacement surgery candidates with osteoarthritis (OA) of the hip or knee, and to validate the different CPs.</p> <p>Methods</p> <p>Patients (n = 353) completed the Brief Pain Inventory (BPI), the WOMAC Arthritis Index, and the SF-36 health status measure. Optimal CPs for categorizing average pain with three severity levels were derived using multivariate analysis of variance, using different CP sets for average pain as the independent variable and seven interference items from the BPI as the dependent variable. To validate the CPs, we assessed if patients in the three pain severity groups differed in pain as assessed with WOMAC and SF-36, and if BPI average pain with the optimal CPs resulted in higher correlation with pain dimensions of the WOMAC and SF-36 than other CPs.</p> <p>Results</p> <p>The optimal CPs on the 0–10 point BPI scale were CP (4,6) among hip patients and CP (4,7) among knee patients. The resulting pain severity groups differed in pain, as assessed with other scales than those used to derive the CPs. The optimal CPs had the highest association of average pain with WOMAC pain scores.</p> <p>Conclusion</p> <p>CPs for pain severity differed somewhat for patients with OA of the hip and knee. The association of BPI average pain scores categorized according to the optimal CPs with WOMAC pain scores supports the validity of the derived optimal CPs.</p

Morgenstell - en forutsigbar handling? : en kvalitativ studie om grunnlaget for sykepleieres beslutninger før, under og etter morgenstell

Studiens formål er å synliggjøre grunnlaget for de beslutninger sykepleiere gjør i morgenstell. Ved å avdekke kunnskap om sykepleieres beslutningsgrunnlag i morgenstell kan forhåpentligvis studien stimulere sykepleiere til videre refleksjon over eksisterende praksis. Studiens teoretiske forankring tar utgangspunkt i Kims (1987, 1994) domene og praksisteori, samt Erauts (1994) empiriske modell om profesjonell utøvelse og livslang læring. En gjennomgang av internasjonal sykepleielitteratur viste at lite er beskrevet om kliniske overveielser sett i sammenheng med morgenstellsituasjonen. Metode. Studien har et kvalitativt design, med hermeneutisk tilnærming. Studiens tyngdepunkt befinner seg innenfor objektiverende hermeneutikk. 6 sykepleiere ved ortopedisk avdeling ble observert i to morgenstellsituasjoner hver - totalt 12. Gjennom semi-strukturerte intervju ble det stilt spørsmål ut fra hva som var observert og det teoretiske rammeverket. Analysemodellen er utformet med bakgrunn i Erauts empiriske modell og Kims rammeverk for praksisteorier. I analysen av sykepleierenes overveielser og helheten i morgenstellene er Betti's (her i Alvesson & Skõdberg 1994 ) hovedkriterier benyttet. Resultater. Studiens funn av likheter, nyanser og forskjeller indikerer at sykepleierenes grunnlag for beslutninger i morgenstellsituasjonene indikerer to ulike tilnærmingsmåter. Sykepleierene anvender overfor pasientene i morgenstell-situasjonene - åpen eller rigid tilnærmingsmåte. Sykepleierenes åpne tilnærmingsmåte sees som en sammensatt sykepleierkompetanse, som inneholder alle grunndimensjonene i et dynamisk samspill, med tyngdepunktet i det etiske grunnlaget. I møte med pasienten vektlegger disse sykepleierene pasientens kunnskap om og opplevelse av sin situasjon, og justerer sine kliniske overveielser i forhold til dette, når beslutningene foretas. Sykepleierene gjør bruk av sin implisitte kunnen. En rigid tilnærmingsmåte blant sykepleierene viser til en mer statisk sykepleierkompetanse, uten overslag av den etiske grunndimensjonen, og kliniske overveielser skjer ut fra egen erfaring og kunnskap, og rutiner, vaner og avdelings fellesmål. Pasientens kunnskap om og opplevelse av sin egen situasjon blir ikke vektlagt i handling eller som grunnlag for beslutninger. Konklusjon. Morgenstell kan til en viss grad planlegges. I møte med pasientene må sykepleierene avsette tid til å lese situasjonene. En sammensatt sykepleierkompetanse er viktig grunnlag for å få tak i pasientenes opplevelse av egen situasjon, og for sykepleierenes overveielser av hva som er egnene handlinger. Anvendelse av implisitt kunnen bidrar til at sykepleierene overveier hva som passer i hvert enkelt morgenstell før beslutninger foretas

Psychometric properties of the Brief Pain Inventory among patients with osteoarthritis undergoing total hip replacement surgery

Abstract Background: Pain is a cardinal symptom of osteoarthritis (OA) of the hip and important for deciding when to operate. This study assessed the internal consistency reliability, validity and responsiveness of the Brief Pain Inventory (BPI) among patients with OA undergoing total hip replacement (THR). Methods: We prospectively included 250 of 356 patients who were accepted to the waiting list for primary THR surgery. All participants responded to the BPI, WOMAC and SF-36 at baseline and 1 year after surgery. Results: Internal consistency reliability (Cronbach’s a) was >0.80 for the BPI, the WOMAC and five of the eight SF- 36 scales The pattern of associations of the two BPI scales with corresponding and non-corresponding scales of the WOMAC and SF-36 largely supported the construct validity of the BPI. The responsiveness indices for change from baseline to 1 year after THR ranged from 1.52 to 2.05 for the BPI scales, from 1.69 to 2.84 for the WOMAC scales, and from 0.25 (general health) to 2.77 (bodily pain) for the SF-36 scales. Conclusions: The BPI showed acceptable reliability, construct validity and responsiveness in patients with OA undergoing THR. BPI is short and therefore is easy to use and score, though the instrument offers few advantages over and duplicates scales of more comprehensive instruments, such as the WOMAC and SF-36

Role of self-efficacy and social support in short-term recovery after total hip replacement: a prospective cohort study

Background: Despite the overall success of total hip replacement (THR) in patients with symptomatic osteoarthritis (OA), up to one-quarter of patients report suboptimal recovery. The aim of this study was to determine whether social support and general self-efficacy predict variability in short-term recovery in a Norwegian cohort. Methods: We performed secondary analysis of a prospective multicenter study of 223 patients who underwent THR for OA in 2003–2004. The total score of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at 3 months after surgery was used as the recovery variable. We measured self-efficacy using the General Self-Efficacy Scale (GSES) and social support with the Social Provisions Scale (SPS). Preoperative and postoperative scores were compared using Wilcoxon tests. The Mann–Whitney U test compared scores between groups that differed in gender and age. Spearman’s rho correlation coefficients were used to evaluate associations between selected predictor variables and the recovery variable. We performed univariate and multiple linear regression analyses to identify independent variables and their ability to predict short-term recovery after THR. Results: The median preoperative WOMAC score was 58.3 before and 23.9 after surgery. The mean absolute change was 31.9 (standard deviation [SD] 17.0) and the mean relative change was 54.8% (SD 26.6). Older age, female gender, higher educational level, number of comorbidities, baseline WOMAC score, self-efficacy, and three of six individual provisions correlated significantly with short-term recovery after THR and predicted the variability in recovery in the univariate regression model. In multiple regression models, baseline WOMAC was the most consistent predictor of short-term recovery: a higher preoperative WOMAC score predicted worse short-term recovery (β = 0.44 [0.29, 0.59]). Higher self-efficacy predicted better recovery (β = −0.44 [−0.87, −0.02]). Reliable alliance was a significant predictor of improved recovery (β = −1.40 [−2.81, 0.01]). Conclusions: OA patients’ general self-efficacy and the expectation of others’ tangible assistance predict recovery after THR. Researchers and clinicians should target these psychosocial factors together with the patients and their families to improve the quality of care and surgical outcomes

Patient information and emotional needs across the hip osteoarthritis continuum: a qualitative study

Background Osteoarthritis (OA) is the most common form of arthritis worldwide, affecting a growing number of people in the ageing populations. Currently, it affects about 50 % of all people over 65 years of age. There are no disease-modifying treatments for OA; hence preference-sensitive treatment options include symptom reduction, self-management and surgical joint replacement for suitable individuals. People have both ethical and legal rights to be informed about treatment choices and to actively participate in decision-making. Individuals have different needs; they differ in their ability to understand and make use of the provided information and to sustain behaviour change-dependent treatments over time. Methods As a part of a larger research project that aims to develop and test a web-based support tool for patients with hip OA, this paper is a qualitative in-depth study to investigate patients’ need for information and their personal emotional needs. We invited 13 patients to participate in individual interviews, which were audiotaped. The audio-tapes were transcribed verbatim and analysed using an inductive thematic analysis approach. Results The thematic analysis revealed a pattern of patients’ information and emotional needs, captured in several key questions relevant to the different stages of the disease experience. Based on these results and research literature, we developed a model illustrating the patients' disease experience and treatment continuum. Six phases with accompanying key questions were identified, displaying how patients information and emotional needs arise and change in line with the progression of the disease experience, the clinical encounters and the decision-making process. We also identified and included in the model an alternative route that bypasses the surgical treatment option. Conclusion Patients with hip OA are in great need of information both at the time of diagnosis and further throughout the disease development and care continuum. Lack of information may result in unnecessary and dysfunctional misconceptions, underuse of potentially helpful treatment options and uninformed decisions. Patients need continuous support from health professionals and their families in order to find and consider effective treatment strategies

Additional file 1: of Role of self-efficacy and social support in short-term recovery after total hip replacement: a prospective cohort study

Age and gender differences in baseline responders and nonparticipants. Table presenting a comparison of age and gender in patients who accepted to participate vs patients who refused to participate. (DOCX 12 kb

Additional file 2: of Role of self-efficacy and social support in short-term recovery after total hip replacement: a prospective cohort study

Baseline differences among responders and nonresponders. Table presenting baseline scores of WOMAC, SPS and GSES among responders and nonresponders and a comparison of group differences. (DOCX 13 kb